1. Worldwide, the addition of treated wastewater (i.e. effluent) to streams is becoming more common as urban populations grow and developing countries increase their use of wastewater treatment plants. Release of treated effluent can impair water quality and ecological communities, but also could help restore flow and maintain aquatic habitat in water-stressed regions. To assess this range of potential outcomes, we conducted a global review of studies from effluent-fed streams to examine the impacts of effluent on water quality and aquatic and riparian biota. 2. We identified 147 quantitative studies of effluent-fed streams, most of which were from the U.S.A. and Europe. Over 85% of the studies identified water quality as a primary study focus, including basic physical and chemical parameters, as well as trace organic contaminants. Nearly 60% of the studies had at least some focus on aquatic or riparian biota, primarily fish, aquatic invertebrates, and basal resources (e.g. algae). 3. Effluent inputs generally impaired water quality near discharge points, mainly through increased water temperature, nutrients, and concentrations of trace organic contaminants, but also via decreased dissolved oxygen levels. The majority of ecological studies found that basal resources, aquatic invertebrates, and fish were negatively affected in a variety of ways (e.g. biodiversity losses, replacement of sensitive with tolerant species). However, several studies showed the im